We conducted an additional analysis to assess whether tramadol use is associated with an increased risk of fatal hypoglycemia, defined as an in-hospital death following a hypoglycemia-related hospitalization. For this analysis, the caseswith such in-hospital deaths were similarly restricted to those who transiently used tramadol (<6 exposed control periods).For both hypoglycemia hospitalization and fatal hypoglycemia, conditional logistic regression analysis was used to estimateORs with 95% CIs comparing exposure in a 30-day risk period immediately before the hospitalization for hypoglycemiawith that of 11 previous 30-day consecutive control periods. Overall, there was no evidence of an exposure timetrendin the year before the event date, thus satisfying one of the key assumptions of this approach (additional informationregarding the assessment of the exposure time-trend canbe found in eMethods 2 in the Supplement).22 All analysesdescribed here were performed using SAS, version 9.3 (SASInstitute Inc).
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